MEDICARE: MR. GIRISH REDDY SANDADI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	24535	TX

General Provider Information

NPI Number	:	1043445943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GIRISH REDDY SANDADI DDS

Provider Business Mailing Address
First Line	:	415 S 6TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-5518
Country	:	US
Telephone Number	:	361-664-0145
Fax Number	:	361-664-2248

Provider Business Practice Location Address
First Line	:	415 S 6TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-5518
Country	:	US
Telephone Number	:	361-664-0145
Fax Number	:	361-664-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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